2014 / Sheri Fink

Sheri Fink, author of Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, is the recipient of the 2014 Ridenhour Book Prize. In this book, reconstructing the events at Memorial Medical Center in New Orleans during Hurricane Katrina in August of 2005, Fink draws upon more than five hundred interviews to bring the reader into the lives of the doctors and nurses who struggled to preserve life amidst chaos.

In discussing its decision, the awards committee said, “Hurricane Katrina and the subsequent flooding when the federal levee system failed triggered catastrophes all over New Orleans. One of the many was at Memorial Medical Center, where the electricity had failed and the hospital complex was surrounded by floodwater. Sheri Fink’s Five Days at Memorial shows how a valiant crew of doctors and nurses confronted a host of medical and ethical issues while trying to treat desperately ill patients under the worst possible conditions. There are no easy answers, and Fink doesn’t provide them. Instead, she shows what these health-care practitioners faced and tells what they were thinking, and she makes readers wonder what they would have — could have — done under similar circumstances. This is a harrowing addition to the growing canon of Katrina literature, and it is one of the best.”

Five Days at Memorial paints a vivid picture of ill patients first left vulnerable to an ad-hoc evacuation plan, and then to a cascade of decisions made by exhausted doctors and nurses about whose lives could be preserved and who would most likely die in the face of serious illness and limited medical care. The consequence was an almost unthinkable tragedy: Several health professionals injected patients with morphine and the fast-acting sedative Versed. At least twenty patients died after being injected.

Upon hearing that she had been awarded the prize, Fink said, “Ron Ridenhour knew about secrets in New Orleans — he spent a year investigating a tax scandal there, reporting that won a George Polk Award. Here the subject is different, but the questions are similar: To what degree do entrusted institutions function in the public interest? How do individuals within them handle consequential decisions, and what implications do past events carry for our future? It’s a tremendous honor to accept the Ridenhour Book Prize for Five Days at Memorial.”

2014 Book Prize Speeches

Transcript of Eyal Press’s speech

EYAL PRESS:Thank you, Danielle, and good afternoon. In August of 2009, four years after Hurricane Katrina struck the city of New Orleans, the New York Times published a remarkable investigative story titled “The Deadly Choices at Memorial.” Written by Sherri Fink, a reporter who happens also to be a doctor, the piece reconstructed what transpired during the hurricane at Memorial Hospital where 45 corpses were discovered after the storm, more than in any other hospital in New Orleans of comparable size.

As Fink showed in her article, which was based on more than 100 interviews and went on to win the Pulitzer Prize, these deaths were not simply the product of a natural disaster. They were the product of fateful choices made by medical professionals, in particular the choice to hasten the death of at least 17 patients by injecting them with morphine and sedatives because evacuating them to safety was deemed unfeasible, a decision made without input from the patients or their family members.

Four years after that remarkable story appeared, Sherri Fink published Five Days at Memorial: Life and Death in a Storm Ravaged Hospital, which has been selected as the winner of this year’s Ridenhour Book Prize. Now, I don’t think the judges who determined the prize knew this, but if it had been up to Sherri alone, I don’t think her book would have been eligible for the prize this year because she would still be working on it. [laughter]

As her editor at Crown, Vanessa Mobley, who I know personally because she was the editor of my own first book, informed me recently, I’m quoting, “Sherri’s devotion to reporting and arriving at her own understanding of the events at Memorial was so complete that she reported and wrote her book until what is, in book terms, the 11th hour. We were going to press and the book was changing near daily as a result of the conversations she continued to have with her subjects.”

That’s a polite way of saying we had to twist Sherri’s arm a little because she’s such a perfectionist. But it’s also why Five Days at Memorial is the extraordinary book it is. On one level, the book is a superb piece of narrative journalism and investigative reporting. Putting readers in the shoes of doctors, nurses and patients trapped in a disaster zone. On another level, it is a searching exploration of medical ethics and accountability that poses much larger questions. Which patients should be treated first in a crisis? Which patients shouldn’t be treated? Should medical professionals have the right to hasten the death of some patients without consulting their family members or anyone else, and then be immune from lawsuits for the decisions they’ve made?

This is the position some doctors at Memorial adopted. It is not the position of the Institute of Medicine, a highly respected organization that issued a report after Fink’s initial article in the Times concluding “neither law nor ethics support the intentional hastening of death even in a crisis.” For helping to spark a public debate about this question, and for exploring this freighted subject with a tenacity and moral seriousness that Ron Ridenhour would have admired, I’m honored to present Sherri Fink with this year’s Ridenhour Book Prize. [applause]

Transcript of Sheri Fink’s speech

SHERI FINK: Thank you so much. I’m deeply grateful to everybody who works on the Ridenhour Prize for this honor. And also to my long suffering editor, Vanessa, who you just heard about, and to Crown Publishing for believing in this book and this story and believing that it was important to get it out. And also to my agent, Tina Bennett, who really believed in this as well and the importance of this story.

It’s been a wonderful chance finding out about this award to learn more about Ron Ridenhour. Of course, I spent a lot of time in New Orleans researching the book and it’s been tremendous to get to know him, and also the work of the foundations and the organizations that support this award. So, thank you for that as well.

Do exceptional times call for exceptions to moral rules? Or does a time of crisis call for an even deeper commitment to our fundamental moral values? This is one of the questions that’s at the heart of Five Days at Memorial. And just to give you a sense of the situation there, Memorial Medical Center was, as some of you New Orleanians know, former Baptist Hospital, a really venerable community hospital in New Orleans, had been around since 1926. And then it was surrounded by flood waters after the levies failed following Hurricane Katrina in 2005, drowning one of America’s most beloved cities.

This was the city where Ron Ridenhour did his investigative work exposing this tax scandal and other work he did there. Memorial Medical Center had a backup power system, but like many American hospitals, very expensive to configure that backup system to run the air conditioning. So that didn’t work and it immediately got very hot there.

And it had another vulnerability which I’ve since learned is common in American hospitals in flood zones, and we saw it just in 2012 with Hurricane Sandy, which is that the backup power system was not protected against flooding. And believe it or not, still there’s no federal rules about them having to be protected, to have to retrofit hospitals in that way. It’s, again, very expensive to do that.

So they knew that within hours all power could fail as the waters began rising. There were about 250 patients, about 2,000 people, doctors, nurses, staff and family members. And helicopters began arriving, but they could take one or two patients at a time and there were so many. So, think about it. Who would you save first if you had to make those difficult, difficult choices that these front line health workers had to make?

And then the next day, all power did fail and there were pets there. For hurricanes, if you want them to work at a hospital, you let them bring their pets and they started to euthanize those pets thinking there was no way they could get them out. It was taking so much time to get the people out. A day after that, with the situation getting worse, with helicopters arriving slowly, some patients dying, pretty much all medical care breaking down, somebody started to raise the question, should we think about putting some of the patients out of their misery? And just think again how you would deal with that question.

So, in all, some 20 patients were given morphine and a powerful sedative, Versed, one or the other or both, and died in those last hours two days after the flood waters rose, a day after the power cut out. Some were patients that doctors had already been sort of saying, “Well, we do too much for these turkeys anyways. They’re very elderly, they have so many medical problems. Maybe we’re giving them too much medical care.” But there were some who weren’t teetering on the edge of life. One was a 63 year old man, grandfather, had fed himself breakfast that morning, asked his nurses, “Are we ready to rock and roll?” And he was very heavyset and he was paralyzed and literally the people I interviewed who spoke about him felt they couldn’t carry him down the steps of the seven stories that he was on with no working elevators, let alone with the helicopters when they carried him up to the helipad, be able to carry someone of his 400 pounds. We have a lot of people in America who weigh this much and we need to think about these issues before we face them.

So some medical staff refused to participate. They disagreed and they argued hastening the end of life is not in our job description. And these people were all suffering, were hot, but they’re not in the kind of pain that calls for sedation, let alone mercy killing. The pharmacy’s still working, and so they refused to participate. And after the disaster, some medical staff did as much as they could to hide the truth of what had happened there. And others spoke out about what had been done to the media and to investigators. And they faced a high price in ostracism from the community and criticism.

I heard some of these early stories in the early media reporting and I thought I had, as a doctor, been reporting in disaster zones and had worked as an aid worker in a number of war and disaster zones. But I’d never heard of anything like this outside of the realm of fiction. And I really thought I want to find out what really happened here. Because it seemed like there might be some urgent lessons for us to take away from it, whatever that was.

And so a year after the disaster, a doctor and two nurses were arrested and accused of second degree murder. And a prosecutor struggled before a grand jury trying to, as he put it, apply justice to a war zone. So in some ways, the context here, you had the failure of the levies, you had the failure of the hospital corporation to send rescue helicopters quickly. You had such slow government rescue efforts that have been the subject of numerous exposes and hopefully lessons. But on the other side, of course, we do have laws in war zones and we can in every place I’ve worked, and I’m sure many of you in crisis situations, we always face difficult questions. So again, this question, do exceptional times call for exceptions or call for an even deeper commitment to fundamental moral values, and not an easy question to answer.

The story was challenging. Many people refused to talk, understandably. There was an active public relations campaign to discredit the prosecutors, to discredit journalists and the people who were the truth tellers in this case as well, the people within the hospital. There were those who not only failed to tell the truth but actually lied about it and attacked those who did.

There was something like 70 Jane and John Does from the hospital who sued after the grand jury didn’t indict and some officials wanted to release some 10,000 pages of documents, 50,000, to the media. There was an active effort by these Jane and John Does to keep those records sealed. They did not want the truth, they didn’t want their own testimony, their own interviews with investigators to be released, for understandable reasons. Again, there were many stakes here.

I’m grateful to those who did speak to me, and not only those who did because they thought what happened was wrong, but most especially to those who participated and thought that what they did was right. Thought that this was the merciful thing and the only option that they had at that point. Because what the others failed to see is the importance of understanding the stakes of another type of triage; this question of how much we take money away from our everyday priorities and apply them to preparing for these rare but potentially catastrophic events. And only when we see the stakes, when we see the truth of what happened in this one hospital and what these poor people were faced with and the difficult choices, can we begin to make informed decisions about preparedness for our society, for our institutions, for our private and public institutions, and for our own families and our own selves.

So, this is about our responsibility to look at these questions. And the end of the book shows how creative thinking and flexibility and the fight for more resources saved lives even in the end, the pets who hadn’t been euthanized were saved when somebody remembered that a doctor had a boat on a trailer in the neighborhood and they went out and hotwired it and brought it back and started bringing out people even with their pets at that point.

So we cannot know what we would have done if we were in these healthcare provider situations in this horrific situation. But we can think in advance. We have the ability to think in advance what we would want to do. And I think that that is really valuable, and certainly everywhere I’ve worked, I’ve really seen the incredible potential of individuals. It seems like always the institutions fail us sometimes in these crises. But individuals, you and me, the people in the immediate vicinity of a crisis, have a huge potential to make a positive difference in life and death situations. So I hope that that’s what people will take away from this book.

In this age of rising seas and ever quickening pace of natural disasters, we can and we must learn. Thank you. [applause]